General evaluation and decision-making in primary vertebra tumors: WFNS spine committee recommendations

Primary vertebral tumors (PVT) are rare neoplastic lesions distinct from metastatic spinal tumors. Due to their diverse nature and complex management, the World Federation of Neurosurgical Societies (WFNS) Spine Committee aimed to establish a consensus on the classification, diagnosis, and treatment of PVT to standardize clinical practice and improve patient outcomes. A systematic literature review including last 10 years was conducted using PubMed, Medline, and Google Scholar, focusing on PVT diagnosis and treatment. After applying exclusion criteria, 12 relevant articles were selected. Additionally, the WFNS Spine Committee convened two consensus meetings, employing the Delphi method. Spine experts participated in structured discussions and anonymous voting, with consensus defined as ≥66 % agreement. Core topics included classification, diagnostic modalities, and treatment strategies. PVT were categorized as benign or malignant, requiring distinct diagnostic and therapeutic approaches. MRI was recommended for tumor evaluation, while CT was preferred for assessing bony involvement. Biopsy was deemed essential for histopathological confirmation. Benign tumors were managed with curettage or en-bloc resection, with pharmacologic options for selected cases. Malignant PVT management included radiotherapy, chemotherapy for specific tumors, and en-bloc excision for resectable cases. Stereotactic body radiation therapy is suggested for unresectable tumors. The necessity of a multidisciplinary approach is emphasized. Standardized classification, advanced imaging, and multidisciplinary approach are essentials for managing PVT. The WFNS Spine Committee’s recommendations provide a structured framework to guide diagnosis and treatment, improving decision-making and patient care.